E-DRUG: Accelerating access report 29 May meeting
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[copied from
http://www.unaids.org/acc_access/contact_group/index.html
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Summary of the 3rd meeting of the Contact group on
Accelerating Access to HIV/AIDS-related Care, Geneva,
29 May 2001
On 29 May 2001, the third meeting of the Contact Group on
Accelerating Access to HIV/AIDS-related Care was held in
Geneva. The Contact group was established by the
UNAIDS Programme Coordinating Board (PCB) a year ago,
in June 2000, to share information and to advise the
UNAIDS Cosponsors and Secretariat on accelerating
access to HIV care, support and treatment.
The 3rd meeting followed the pattern of the previous meeting
and comprised four sessions. In the first session, the
Contact Group heard country reports from Gabon, Morocco
and Barbados. The presentation from Barbados also
covered regional initiatives in the Caribbean, and was
followed by presentations on behalf of other sub-regions in
Africa, given by Mali (for ECOWAS), the Republic of Congo
(for Central Africa) and South Africa (representing SADC).
These presentations demonstrated the considerable
progress made at country level in the twelve months of
accelerating access and the momentum building up around
regional and sub-regional approaches.
In session 2, participants were updated on progress at the
international level, in presentations from WHO, the UNAIDS
Secretariat, NGOs and the research and development-
based pharmaceutical industry. The first presentation, from
WHO, provided information on progress in selected areas
of access, including pricing information, pre-qualification of
suppliers for HIV-related drugs and differential pricing, within
a framework comprising four key elements � the rational
selection and use of drugs and diagnostics, affordable
prices, sustainable financing and reliable health systems.
The updated report, �Sources and prices of selected drugs
and diagnostics for people living with HIV/AIDS� produced by
WHO, UNICEF and MSF, is due to be released this week.
The UNAIDS Secretariat made a presentation on resource
mobilisation, highlighting the challenge to raise the needed
level of resources, the principles which should apply when
considering how to fund care, support and treatment and
the various approaches adopted by national governments to
raise funds for greater access to HIV/AIDS-related drugs.
The proposal for a global fund for AIDS and health was
discussed in this context.
The NGO representative addressed a broad range of
issues, including the need for the close and continuing
involvement of civil society in access initiatives, the need for
a complementary process for accelerating access to
diagnostics, more transparency in the process of country
missions and price negotiations, a wider geographic spread
and redoubled efforts to reach all those needing HIV/AIDS-
related care and support.
The representative of the research and development-based
pharmaceutical companies spoke of progress in making
HIV medications more affordable and described some of the
individual actions of the five companies which signed the
Joint Statement of Intent in May 2000 in improving the
affordability and availability of a range of medicines. The
commitment of industry to the goal of accelerating access,
through country-led processes, was reiterated.
In session 3, a technical update on voluntary counselling
and testing was presented. This provided data about the
impact of voluntary counselling and testing interventions on
prevention, as an entry point to care and as a critical entry
point for the prevention of mother to child transmission. A
number of challenges for voluntary counselling and testing
programmes were identified, including reaching vulnerable
groups, increasing the efficiency and reducing the costs of
testing, ensuring the quality of programmes, addressing
stigma and discrimination and scaling up voluntary
counselling and testing programmes.
The final session provided the opportunity for open
discussion of the many substantive issues which had
emerged from the various presentations and interventions
earlier in the meeting. The key issues raised for further
consideration and action were:
The need for a balanced �package� of care, which
includes redoubled efforts to increase the availability and
affordability of drugs and medicines, but also encompasses
such critical elements as scaled-up voluntary counselling
and testing programmes, medical training which takes
account of the HIV/AIDS epidemic, increased access to
diagnostics and better monitoring. While significant price
discounts for antiretroviral therapy have been achieved,
reducing costs to 10% to 20% of world prices in some
instances, the vast majority of people affected by HIV/AIDS
remain without access to even basic drugs and medicines.
Ensuring that essential care � palliative care, prophylaxis
and treatment for opportunistic infections � is rolled out
rapidly is as critical a challenge as making ARVs more
widely available.
The urgent need for strengthened health systems, to
ensure that care, treatment and support can be effectively
delivered and sustained. Now that the lower price of drugs
is beginning to bring treatment within the reach of more
people affected by HIV/AIDS, the urgent need to build up
health infrastructures and strengthen health systems has
come into sharper focus on the care agenda. AIDS can be
seen as a new driving force � a fresh catalyst � for
addressing the perennial problem of health systems.
The usefulness of regional and sub-regional
collaboration, in sharing knowledge and experience and
developing collective strategies. Regional and sub-regional
approaches are beginning to emerge and to prove useful to
complement the country by country process. The potential
for such collaboration to expand the benefits of improved
access to care, for example through the possibility of bulk
purchasing, shared technical assistance and joint
resourcing, is still to be realised � but it is clear that an
important start is being made.
The need for greater transparency and information
sharing, about achievements in accelerating access,
prices and processes. Interest was registered at the
meeting in a broader dissemination of the basic elements of
countries� experience in successfully negotiating for
reduced prices, in greater reporting on country missions
involving the UN and in even greater transparency on
agreed prices. The report, �Sources and prices of selected
drugs and diagnostics for people living with HIV/AIDS� will
contribute to this greater transparency. UNAIDS recognises
the need to be still more proactive in publishing information
� not just putting it on the web-site.
The importance of integrating care and prevention
more effectively, and finding new ways to achieve this
integration. There are few truly effective models for
achieving this balance at present. Voluntary counselling
and testing was recognised as a critical intervention linking
both prevention and care, with access to treatment
encouraging testing, and testing potentially leading to
access to care.
The obligation to remain vigilant about the risks and
realities of drug resistance, and to implement effective
programmes of monitoring and evaluation. If we are going to
do it, we must do it well. Fundamental to maintaining the
gains realised through lower prices is vigilance to the risks
of drug resistance. Careful monitoring of antiretroviral
therapy is essential to safeguard the value of the current
generation of drugs for as long as possible. WHO is
leading work on this.
The need for greatly increased resources � the
encouraging development of the global fund was noted, and
the opportunity to shape its governance and mandate in the
process of stakeholder consultations leading up to the
establishment of the fund was welcomed. The group had a
particular interest in ensuring that developing countries have
a key role in decision-making in the proposed fund and that
processes are decentralised.
The need to continue to achieve price reductions,
through all possible means including strengthened
competition, differential pricing and use of generics.
Reductions in middle income countries and countries with
low HIV incidence, where they can be seen to have the
greatest impact, should be a focus for greater attention.
The need for continuing technical assistance from UN
agencies, for procurement, quality assurance, certification
and support to health systems.
The meeting concluded that after one year, the process of
accelerating access has taken off, and the focus of
attention for the Contact Group can now shift from
matters of principle to practical action and
implementation. The opportunities to build positively on
the changes achieved through collective efforts over the
past year are becoming clearer and should be actively
pursued.
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